FAQ About Endoscopic Thoracic Sympathectomy (ETS)

Is sympathectomy right for me?

Our physicians meet with every potential surgical patient on a one-to-one basis to review your past medical history and current symptoms. The consultation appointment is usually 30 to 60 minutes in length and we encourage you to bring your questions with you to this appointment. Please feel free to bring along a friend or family member who can help you remember the information covered during the consultation appointment. Every case is unique and our physicians thoroughly assess each patient before making a clinical decision.


Where is the procedure performed?

The Thoracoscopic Sympathectomy is performed at the University of Maryland Medical Center, a world-renowned teaching institution at the forefront of medical education and research. The Medical Center has state-of-the-art operating rooms with all of the newest videoscopic equipment. We are located at 22 S. Greene Street, Baltimore, MD.


Who performs sympathectomy?

At UMMC, we have two board certified thoracic surgeons who perform sympathectomy, Dr. Whitney Burrows and Dr. Shamus Carr. They are both experienced in minimally invasive thoracoscopic surgery and have performed this procedure on many patients with great success.


What are the possible risks of sympathectomy?

As with any surgical procedure, having an ETS carries some level of risk. Some risks are related to general anesthesia and chest surgery, including bleeding, infection, and pneumothorax or lung collapse. Others are related specifically to the ETS procedure. The risks specific to sympathectomy include compensatory sweating and Horner syndrome.


What is Compensatory Sweating?

Compensatory sweating refers to more sweating that occurs in other parts of the body – usually the chest, back or legs – rather than the original site of hyperhidrosis. This may happen in approximately 50 percent of patients to varying intensities. Compensatory sweating can occur immediately after surgery or months later. Sometimes the compensatory sweating resolves itself.


What is Horner's Syndrome?

Horner syndrome is caused by damage to the stellate ganglion at the top of the sympathetic nerve chain between the sixth and seventh vertebrae of the neck. (This area is avoided as much as reasonably possible by the surgeon to prevent this condition.) This results in decreased facial sweating, eyelid drooping, and an enlarged pupil on the opposite side. Horner syndrome is more likely to occur when a surgeon must work higher up on the sympathetic nerve chain, such as when treating facial blushing. A minor plastic surgery procedure can correct the eyelid drooping, and the other symptoms are not externally obvious to the untrained person.


Do you clip or cut the sympathetic nerve chain?

Our practice at the University of Maryland Medical Center is to cut the sympathetic nerve chain. This method involves cutting the sympathetic nerve chain with an electric cautery. This method allows for improved success because it ceases the function of that particular nerve segment.


Can sympathectomy be an option for facial blushing or facial sweating?

Each individual is evaluated on a case-by-case basis and, depending on your symptoms, you may be an appropriate candidate for sympathectomy to treat facial blushing or facial sweating. Be aware that when used to treat facial blushing or facial sweating, ETS may involve operating higher on the sympathetic nerve chain. This poses a greater risk of Horner syndrome if the surgeon needs to cut the chain at a higher level.


Is sympathectomy covered by my insurance?

Generally speaking, most insurance companies will cover the procedure if they consider treating hyperhidrosis a medical necessity. It is best to verify coverage with your insurance company for the procedure. Many insurance companies require documentation that the patient has first tried medical or conservative treatment before considering surgical treatment.

For patients who are not covered by any kind of medical insurance, our office can assist you with making financial arrangements.


Can I speak with a patient who has already had a sympathectomy?

Yes. After your consultation appointment, we can arrange for you to speak with a patient who has already undergone sympathectomy.


How can I arrange for more information or set up a consultation appointment?

To learn more about sympathectomy, please call 410-328-6366.